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j� APPLICATION FOR SANITATION PERMIT Permit No. __9�_ 1 ' t in Duplicate)(Complete p� ) Date Issued T L-1 Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 'LOCATION----!�-G�4 R.----8- �� v----_----�------ --------�---1-•,---- Owner's Name-----'-�/-' `------•--- T--V--In-4...................-----=------------------------------------------------- ------- Phone------------------------------------ Address------------_--.��Q ......�.l---------------------------------------------------------------------------------------•-•-•- Contractor's Name........ IS --------- ------------------------------.......................... Phone................................... Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�/.-__ Number of bedrooms .-2--Number of baths ---�/___ Lot size _____ ' 1.�4-.- Water Supply: Public system ❑ Community system ❑ Private R Depth to Water Table,FS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E� Hardpan ❑ Previous Application Made: Yes ❑ No g New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_;--------------Distance from foundation__._---__--_--_----Material_-__---_.----_------_-;_---_______-.--_----___-_. ❑ No. of compartments-------------- -----------Size-----------•---•--------•------Liquid depth-.._-------------------•--Capacity-------------------•--- Disposal Field: Distance from nearest well.... Distance from foundation_._.) ...V__.Distance to nearest lot line. .9—Q•_ �. Number of lines--------/-_-_.------ --.---Length of each line--------IV/401-___.l1-----Width of trench--_.__,;21 ..-;4---- _____________ Type of filter material_--./--,;---_!�iQDepth of filter material-----/I_-_.-..Total length------ a6.....__•___________________ Seepage Pit: Distance to nearest well_/D`,?_/------Distance ffJ�om foundation.....�_6_.1__ 'sten g to nearest lot line-_:- d_•,_. Number of pits-------/-------------Lining material__..(�0. .-f'�..Size: Diameter____p__r._ --- -----.Depth--------.2--S--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------_. ❑ Size: Diameter----------------------------- -------Depth--------------------- ----------- ------Liquid Capacity--------------------------gals. : Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--__------.---_--_----________._-.-__-_--. ❑ Distance to nearest lot line-------------------------------------------------- ----------------------------------------------------------------------------------------- `tel Q Remodeling and/or repairing (describe):----------------- ------------------------•----------•--------------------------------•-•--••----•-•--•--............................................. -•---•--•------•--------•------•---------•--•-•---------------------------------------- --------------------•-•---•--•------••-•----- ----------------------------------------- -•----------------------•------•--•--•------------------••--------------------------•-•--••-------•-----•------..-----•-------•-----------------._..._-•------_..._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------. -- -- -- ---•--�------- �... — ^— ---------------------------------------------------------------(Owner and/or Contractor - ------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- ------ ------ ------------------------------ ----------------------------• DATE---------------------__ ��I-------------------- REVIEWEDBY-----.•_-_------------------------------- - -- -- - - -- --------------------•------------------------------- DATE----------------W--3.1................................. BUILDINGPERMIT ISSUED .-------•--------------------------------------- DATE------------�------------------------------------------- Alterations and/or recommendations------------------_ -- -------------------------------•-----------------------------------•------•------------------------•----------------------------------- �• •'i!-/•-•--------pl--n_..__IJQ.T_...M �i 6_L.�'ts--------1 �r O?,G:.�!.774------ /Ear-A F,12-1....... /(2 --------- -------•----•------•--------•-----•---------------•-------•••--•-• .............. ---•-••-------------•--•------••-•------------ ------•-•--------------------- ------••-------- •--------------------------------------------........................................................................... fJ _..._---...-•-------------••-----------••••--•---•-•-----------•-••----- FINAL INSPECTION BY---------- - - '- Date_------- ----- 1-^-------- ---5--7---------------------•------------- "- SAN JOA4 UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54